Publications
 

Evaluation of Provider Network in the Iowa Dental Wellness Plan during the First Year

McKernan, S.C.; Pooley, M.J.; Ingleshwar, A.; Kuthy, R.A.; Momany, E.T.; Damiano, P.C.
03/2016

Abstract

The Iowa Health and Wellness Plan (IHAWP) is an expansion of health care coverage, allowed as part of the Affordable Care Act (ACA), primarily to single adults with incomes below 133% of the federal poverty level and not otherwise eligible for Medicaid. Dental coverage within the IHAWP is provided through the Dental Wellness Plan (DWP), which is administered by Delta Dental of Iowa (DDIA). 

This report is the second provider network adequacy report, and one of several components, in the ongoing evaluation of the DWP program being conducted by the University of Iowa Public Policy Center (UI PPC). The first provider network adequacy report, describing baseline DWP provider network, was published in March 2015 and is available on the UI PPC website. 1 In the current report, we present updated information about the dental provider network available to DWP members during the first year of DWP implementation (May 1, 2014 to April 30, 2015). In addition, comparisons are made with the provider network in the traditional Medicaid State Plan.

The Medicaid comparison group includes non-institutionalized adults, aged 19 to 64, with at least 1 month of enrollment during May 2014 through April 2015 (comparison group 1). From this group, we identified a subset of adults who were newly eligible during the year through the Iowa Family Medical Assistance Program (FMAP—comparison group 2). Newly eligible Medicaid FMAP members were chosen as a comparison group because they were expected to be the most similar to the DWP population in terms of pent-up demand for dental care; they are also expected to face similar challenges finding a dentist who accepts their insurance.

We considered two groups of dentists to evaluate the DWP provider network: (1) participating dentists, identified administratively by DDIA as members of their provider network, and (2) active dentists, defined in this report as individuals who submitted at least one claim during the study period. This definition of active dentists is also used by the American Dental Association (ADA) and
the Association of State & Territorial Dental Directors (ASTDD) in their Medicaid reporting. Medicaid dentists were also identified based on claims activity; Medicaid does not maintain an updated list of their provider network.

Findings from this assessment will be used in conjunction with other components of the UI PPC’s evaluation to guide comprehensive review of the DWP program.